Glucocorticoid adverse effects

Our topic today was adverse effects of glucocorticoids. These are commonly used drugs with significant adverse effects. If we wish to limit unwanted effects we need to know how common they are, harness patient's concerns to help us and have a plan for when we use steroids.

Your talks showed that you had put effort into researching the topic, but there needs to be a little more planning on the presentation side. The time allowed means that you have to be concise, and to make it sharp you must always be precise. Numbers (10%) not descriptors (quite common). List your sources on the handout so the audience can follow up if they want to.

Here are some useful papers. The links are to abstracts but the full versions are only a password away via ATHENS.

Monitoring adverse effects of low dose glucocorticoid therapy: EULAR recommendations for clinicalk trials and daily practice. MC van der Goes et al Ann Rheum Dis 2010;69:1913-1919

Epidemiology of glucocorticoid-assoiated adverse events. AK McDonough et al. Curr Opin Rheumatol 2008 Mar;20(2):131-7.

Patients’ and rheumatologists’ perspectives on glucocorticoids. MC van der Goes et al. Ann Rheum Dis 2010;69:1015-1021.

The acronym below which is an aide-memoire for reducing adverse drug effects in general. Apologies to its author, who I can't remember, but I first heard it at a meeting about 5 years ago.

S...Stratify: is the patient at higher risk of an ADR: comorbidities, drugs, age.
A...Assess: Hepatitis status, TB risk, vaccinations up to date?
F...Fend-off: vaccinate, optimise health (stop smoking etc).
E...Evaluate: check what ADRs might be expected, look for them.
T...Treat: nip it in the bud (UTI is easier to treat than septic multi-organ failure).
Y...Yearly: re-evaluate all of the above regularly. The frequency depends on the drug.

The topic for next Friday is Nosocomial illness:

Falls
C. Difficile
MRSA
Line infections

Two minutes please. Be concise yet precise. Tell us your sources. you are allowed an A4 (single side) handout.

Audit standard for next week. All casenote sheets have the patient's name and CHI.

MJM